Provider Demographics
NPI:1184710121
Name:ANIGBOGU, NKOLI (MD)
Entity type:Individual
Prefix:
First Name:NKOLI
Middle Name:
Last Name:ANIGBOGU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 N COUNTY ROAD 25A
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1337
Mailing Address - Country:US
Mailing Address - Phone:937-440-4466
Mailing Address - Fax:937-440-4470
Practice Address - Street 1:1050 KENDALL DR STE F
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-4125
Practice Address - Country:US
Practice Address - Phone:909-352-6655
Practice Address - Fax:909-352-6770
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC170662207R00000X
IN01084495A207R00000X
OH35-0803901-A207R00000X
OH35.083901208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2500574Medicaid
OH4128663Medicare PIN
OHI03320Medicare UPIN